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Home My WebLink About14892-ZTOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 14892 Z Permission is hereby granted to: ....... .~.~..~...g~.,....~..~...~..r.. ......... ...... ~....F...~....~. ....... ~..~..z~.7.....~,,,4~. ..... ,o ....... ~.z.v..,1..Z'.~C.~....~.....~...~...,~.c~ .................................................................................. County Tax Map No. 1000 Section .../../.,.,~.- .......... BJ~k '''~Z ............ Lo~ No' I OZ~ ........... pursuon, ,o opplication doted ..../~ ...... ~....~.. .................. , 10~., ond opproved by the Building Inspector. Rev. 6/30/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL EOUTHOLD, N.Y. 11971 TEL.: 765-1802 Disapproved a/c .................................... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and re~uiations, and to admit authorized inspectors on premises and in building for necessary... '.~ .~..inspe 'OHS. :~"o ....~' ~~--' ~tgnarure~g apptlcan/, or name~I a corporanon) s ............. ..... · ' (mailing address of applicant) ...... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................................................................................... Name of owner of premises .0.~.~'1" ~.~ ..... .~.'... ~).~..~..~.~'. ............................................. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No...-~.G..~./ Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location ofland on which proposea work will be done. B&..~&~ ~.,.,~ ~II~"TI'~C,~( County Tax Map No. 1000 Section ..... !!.~ .......... Block ..... ! ............ Lot ........ [~11 ........ Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: Existing use and 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteratio~t' .......... Repair .............. Removal .............. Demolition ...... Other Work... [~l~,l~.~... ,] .,.q~ ~' · ~"~'--~ (Description) 4. Estimated Cost ....... .o.q..O ........................ Fee ~ (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling units on each floor ................ If garage, number of cars ........................................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front... ¥.~ M. tq ...... Rear .... .~.e?. ~.,/.C-. .... Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Dep/h~..'~ ~ .............. Height ...................... Number of Stories ...................... (~ Di/nensitw, s of en'~e new construction: Front .............. Rear ............... Depth ............... He~.ht q.[[~...~..O~.5. ~ £ta,'%3....q. ~lv~.. ~.~.1~,~ .................................. 9. Size bfq.' Fron~... ,.. ................ Rear ...................... pepth ........... , .......... 10. Date of Purchase .... 11~17 ................... : Name of Former Owner .~l~ls~L~.~.~...~..1~.? .~. ~...~I~.~1~ 11. Zone or use district in which premises are situated.., t~q~[lllct~.~¥.~ ................................. 12. Does proposed construction violate any zoni¢g law, ordinance or regulation: .~.~ ........................... 13. Will lot be regraded ...... ~ ......... ~ ........ Will excess fill be removed from premises: Yes ~ 14. Name of Owner of premises ~ ~. ~t}ll~M~lfl'Address ~. .................. Phone $o.~-~,4~p.~.. ~..~. Name of Architect ........................... Address ................... Phone No ................ Name of Contractor .......................... Address ................... Phone No ..... ~ .......... 15. Is this property located within 100 feet of a tidal wetland? * Yes ..... No .W~... · If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and~indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, COUNTY OF J~..,~'..,~.,~..Z..A~. .... S.S .... . .~.-...~..,"-/'e'K~Z~. ·' .............. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) . above named. He is the . ~.o..,~-. ,(.'.,~.' rff..~. ~ .~-. ........................................ (Contractor, agent, corporate officer, etc.) of s~d owner or owne~, ~d is duly auto,ed to perfom or have peffomed the said work ~d to m~e ~d file ~s application; that all s~tements contmed ~ ~is application me true to the best of his ~owledge and be~ef; ~d that ~e work will be perfomed ~ the m~ner set for~ ~ the application filed therewith. Sworn to before me this ........ ~ ...day of. ~ ,19 Not~ P ' - ........................... Cou~ ~',r~,mtssmn ExarCh30. ~